Provider Demographics
NPI:1730470675
Name:SPENCER, NICOLE (DO)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:20375 W 151ST ST STE 463
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7210
Mailing Address - Country:US
Mailing Address - Phone:913-355-8577
Mailing Address - Fax:913-782-2616
Practice Address - Street 1:20375 W 151ST ST STE 463
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7210
Practice Address - Country:US
Practice Address - Phone:913-355-8577
Practice Address - Fax:913-782-2616
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-26
Last Update Date:2024-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0537938208600000X
MO2015007988208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0537938OtherLICENSE
MO2015007988OtherLICENSE